An applicant for a license shall submit an application to the Secretary. The application: Shall be on the form that the Secretary requires; Shall be signed and verified by the individual; and Shall include: The name of the applicant; A statement that the applicant meets the requirements of this subtitle; The location of the proposed hospice; The name of the individual who is to be the medical director of the hospice care program; and Any other information that the Secretary requires.